Coding for Wound Care - APMA

Coding for Wound Care

****IMPORTANT*** Disclaimer

***Information provided is to the best of our knowledge and as current as possible.

***Please verify all policy and reimbursement information with your local Medicare carriers.

? Physicians and other providers must confirm or clarify coding and coverage from their respective payers, as each payer may have differing formal or informal coding and coverage policies or decisions. Physicians and providers are responsible for accurate documentation of patient conditions and for reporting of procedures and products in accordance with particular payer requirements.

Does location matter?

? Laterality does not matter ? Anatomical location does matter

? There are codes for the ? Leg (including the ankle) ? Foot and toes

Size and Code Selection

Clarification

? Select debridement codes based on the deepest level of tissue debrided

? Debridement codes should only be based on the measurement of the wound surface that was actually debrided

? When the entire wound is debrided, the wound measurement after debridement should be reported

? When multiple wounds are debrided at the same depth, combine the debrided surface measurements of all same tissue depth wounds

? Do not bill each wound separately BUT document each depth of wound separately

DEBRIDEMENT CODES NOT INVOLVING SUBCUTANEOUS TISSUE

? 97597 Removal of devitalized tissue from wounds, selective debridement, without anesthesia, wound assessment, topical applications, instructions for ongoing care, total wound surface area first 20 sq cm

---May include scalpel, scissors, waterjet

97598--each additional 20 sq cm

THESE CAN BE BILLED TOGETHER SIZE REFERS TO TOTAL SURFACE AREA OF ALL WOUNDS WITH NO MODIFIER

DEBRIDEMENT CODES INVOLVING SUBCUTANEOUS TISSUE AND DEEPER

? 11042 Debridement, subcutaneous tissue incl epidermis and dermis, first 20 sq cm or less

? 11045 each additional 20 sq cm

The above 2 can be billed together with no modifier as it is an add on code

? BE AWARE OF PLACE OF SERVICE LIMITATIONS ? CHECK YOUR LCD's!!!!!!

DEBRIDEMENT CODES

INVOLVING SUBCUTANEOUS TISSUE AND DEEPER

? 11043 Debridement, musle and/or fascia incl epidermis and dermis and subQ, first 20 sq cm or less

? 11046 each additional 20 sq cm

The above 2 can be billed together with no modifier as it is an add on code

? BE AWARE OF PLACE OF SERVICE LIMITATIONS ? CHECK YOUR LCD's!!!!!!

DEBRIDMENT CODES INVOLVING SUBCUTANEOUS TISSUE AND DEEPER

? 11044 Debridement, bone , incl subcutaneous tissue, muscle, and/or fascia, epidermis and dermis, first 20 sq cm or less

? 11047 each additional 20 sq cm

? The above 2 can be billed together with no modifier as it is an add on code

BE AWARE OF PLEACE OF SERVICE LIMITATIONS CHECK YOUR LCD's!!!!!!

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